Meta-analysis on the mandibular dimensions effects of the MARA appliance in patients with Class II malocclusions

Effects of the Forsus fatigue-resistant device and mandibular anterior repositioning appliance in Class II malocclusion treatment

INTRODUCTION

Fixed functional appliances have been used to treat Class II malocclusion by a huge number of professionals. This retrospective study aimed to analyze the effects of the Forsus fatigue-resistant device and compare the findings with a well-matched group treated with the mandibular anterior repositioning appliance (MARA).

METHODS

The Forsus group was composed of 14 patients at an initial mean age of 12.4 ± 1.3 years, treated with the Forsus fatigue-resistant device followed by a fixed orthodontic appliance. The MARA group comprised 18 patients at an initial mean age of 12.1 ± 1.3 years, treated with MARA followed by fixed orthodontic appliances. The untreated control group consisted of 14 patients matched with the other groups. Posttreatment changes were calculated as T1 - T2. Intergroup comparisons regarding treatment changes were performed using repeated-measures analysis of variance followed by Tukey's test.

RESULTS

During treatment, the Forsus group showed a statistically significant decrease in maxillary protrusion and maxillomandibular sagittal discrepancy in the control group. The MARA group showed significantly greater retrusion of maxillary incisors than the Forsus and the control group. Overjet decreased significantly more in the treated groups in relation to the control group. Molar relationship improved significantly more in both treated groups, and both showed more correction than the untreated control group.

CONCLUSIONS

The Forsus and MARA associated with fixed appliances effectively corrected the Class II malocclusion, mostly using dentoalveolar changes and maxillary growth restriction.

Effects of fixed functional appliances with temporary anchorage devices on Class II malocclusion: A systematic review and meta‑analysis

BACKGROUND

The use of fixed functional appliances (FFAs) in conjunction with temporary anchorage devices (TADs) has been proposed to enhance skeletal changes and reduce proclination of the lower incisors.

OBJECTIVES

To systematically investigate the skeletal and dentoalveolar effects of FFAs with TADs on Class II malocclusion in adolescents.

METHODS

Electronic searches of databases and manual searches of references were performed up to August 30, 2020. Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) focusing on adolescent patients treated with FFAs combining TADs were included. The modified Cochrane risk-of-bias tool (R.O.B 2.0) and ROBINS-I (Risk of Bias in Non-randomized Studies-of Interventions) Tool were used to assess the risk of bias in RCTs and CCTs, respectively. Meta-analyses of SNA, SNB, ANB, Co-Gn, SN-MP, the lower and upper incisor inclination changes were performed. Subgroup analyses and sensitivity analyses were conducted based on TAD types, FFA types, record types and types of study designs.

RESULTS

Ten studies were included with a sample size of 281. Meta-analyses revealed significant differences in the changes in SNB (mean difference [MD] 0.67; 95% confidence interval [CI] 0.04-1.29), ANB (MD -1.22, 95% CI -2.04 to -0.39), Co-Gn (MD 1.57; 95% CI 0.22-2.92), inclination of the lower incisors (MD -5.64, 95% CI -7.78 to -3.50)] and inclination of the upper incisors (MD -1.91; 95% CI -3.69 to -0.13). TAD types and FFA types seem to affect the treatment outcome.

CONCLUSIONS

Compared with FFAs alone, FFAs with TADs exhibit superior skeletal effects and reduce the inclination of the lower incisors in the short term; however, the evidence showed moderate to high risk of bias. Registration number CRD42020177611.

Comparison of treatment outcomes with crowned and banded mandibular anterior repositioning appliance (MARA) in Class II pubertal subjects: A retrospective cohort study

OBJECTIVE

To compare the skeletal and dentoalveolar changes in Angle Class II malocclusion subjects treated with the banded Mandibular Anterior Repositioning Appliance (Ba-MARA) and crowned MARA (Cr-MARA).

MATERIALS AND METHODS

This retrospective cohort study included 40 consecutively treated pubertal adolescents with Class II division 1 malocclusion who received full-fixed orthodontic appliances with a phase of orthopedic treatment using Ba-MARA (n=20) or Cr-MARA (n=20). The samples were compared with 20 untreated Class II controls obtained from the Michigan Growth Study. Lateral cephalograms were obtained pre-treatment (T1), post-MARA removal (T2), and post-full-fixed orthodontic treatment (T3).

RESULTS

After MARA removal (T2-T1), the total mandibular length increased only in the Cr-MARA group compared to controls (Co-Gn=5.4mm; post-hoc P=0.042). Overall dentoskeletal changes were less significant during the T3-T2 timepoint. After full-fixed orthodontic treatment (T3-T1), and after controlling for normal growth, both Ba- and Cr-MARA groups increased the total mandibular length by 3.1mm and 3.8mm respectively. Overjet decreased by 2.2mm in Ba-MARA and 2.9mm in Cr-MARA. The mandibular molars erupted and moved mesially in both treatment groups. The mandibular incisors proclined significantly in the Cr-MARA group in comparison to controls (IMPA=7.1^o, post-hoc P=0.002).

CONCLUSIONS

Both MARA designs were effective in correcting the malocclusion by a combination of small skeletal and dental changes. Although significant differences in dentoskeletal outcomes were observed between the MARA groups and the controls, the differences between the two MARA designs were small and did not achieve statistical/clinical significance.

Dentoskeletal and soft-tissue changes comparison between the Jasper Jumper and Twin Force Bite Corrector in Class II malocclusion patients: A retrospective study

OBJECTIVE

This retrospective study aimed to compare the dentoskeletal and soft-tissue changes in Class II malocclusion patients treated with Jasper Jumper and Twin Force Bite Corrector associated with fixed orthodontic appliances.

MATERIAL AND METHODS

The sample comprised 60 subjects divided into 3 groups. Patients with Class II malocclusion, mandibular retrusion, slight or no crowding and with no previous orthodontic treatment were eligible. Group 1 comprised 20 patients treated with the Jasper Jumper (JJ), with an initial age of 12.39 years. Group 2 comprised 20 patients treated with the Twin Force (TF), with an initial age of 11.83 years. The control group consisted of 20 untreated Class II subjects with an initial age of 12.13 years. Intergroup pretreatment comparisons were performed with One-way analysis of variance and intergroup treatment changes were compared with the Analysis of Covariance, both followed by Tukey test.

RESULTS

The TF group showed greater increase in mandibular length (6.23mm±4.64, P=0.004) than the control group (2.94mm±1.75). The mandibular incisors in the experimental groups presented significantly greater labial inclination and protrusion than the control (Md1.NB; JJ: 4.19°±2.09; TF: 4.46°±6.83; control: 1.13°±2.08, P=0.000/Md1-NB; JJ: 1.95mm±1.45; TF: 1.74mm±1.79; control: 0.31mm±0.81, P=0.000). In addition, the treated groups also showed significantly improvement of the dental relationships (Overjet; JJ: -4.05mm±4.64; TF: -3.80mm±2.12; control: 0.05mm±1.12, P=0.000/Overbite; JJ: -2.52mm±1.46; TF: -2.93mm±2.13; control: -0.63mm±1.35, P=0.000).

CONCLUSION

The Jasper Jumper and Twin Force associated to fixed appliances were effective in correcting Class II malocclusion with a combination of skeletal and dentoalveolar changes. However, the TF seems to provide more skeletal effects with greater maxillary growth restriction and mandibular length increase when compared to the JJ.

Systematic reviews in orthodontics: Impact of the PRISMA for Abstracts checklist on completeness of reporting

INTRODUCTION

This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A).

METHODS

Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores.

RESULTS

Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting.

CONCLUSIONS

The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.

Class II correction in orthodontic patients utilizing the Mandibular Anterior Repositioning Appliance (MARA)

OBJECTIVES

To evaluate skeletal and dentoalveolar changes produced by the Mandibular Anterior Repostioning Appliance (MARA) in the treatment of Class II malocclusion in adolescent patients.

MATERIALS AND METHODS

Lateral cephalograms of 24 patients, mean age 12.40 years, with a Class II malocclusion consecutively treated with MARA were compared with a historical control group. Changes were evaluated using the Pancherz superimposition and grid analysis pre- and posttreatment. Independent sample t-test, Mann-Whitney U-test, and Pearson correlation coefficient analysis were performed.

RESULTS

Significant differences were seen between the treatment and control groups during the 12 month period. Improvement in Class II relationship in the MARA group resulted from skeletal and dentoalveolar changes. There was a 7-mm molar correction and a 4.7-mm overjet reduction. There was also an increase in the mandibular base of 3.3 mm with the lower molar and incisor coming forward 2.6 mm and 2.2 mm, respectively. No significant headgear effect was shown on the maxilla. The maxillary incisor position remained unchanged, whereas the molar distalized 1.8 mm. The anterior lower facial height had an overall increase of 2.2 mm.

CONCLUSIONS

The MARA was successful in achieving a Class I molar relationship and reducing the overjet in Class II malocclusions. This was the result of both skeletal and dentoalveolar changes.

Reliability of Growth Indicators and Efficiency of Functional Treatment for Skeletal Class II Malocclusion: Current Evidence and Controversies

Current evidence on the reliability of growth indicators in the identification of the pubertal growth spurt and efficiency of functional treatment for skeletal Class II malocclusion, the timing of which relies on such indicators, is highly controversial. Regarding growth indicators, the hand and wrist (including the sole middle phalanx of the third finger) maturation method and the standing height recording appear to be most reliable. Other methods are subjected to controversies or were showed to be unreliable. Main sources of controversies include use of single stages instead of ossification events and diagnostic reliability conjecturally based on correlation analyses. Regarding evidence on the efficiency of functional treatment, when treated during the pubertal growth spurt, more favorable response is seen in skeletal Class II patients even though large individual responsiveness remains. Main sources of controversies include design of clinical trials, definition of Class II malocclusion, and lack of inclusion of skeletal maturity among the prognostic factors. While no growth indicator may be considered to have a full diagnostic reliability in the identification of the pubertal growth spurt, their use may still be recommended for increasing efficiency of functional treatment for skeletal Class II malocclusion.